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The following is a guest blog post by Stephane Vigot, President of Caristix, a leading provider of healthcare integration products and services. This post is part of the Optimize Healthcare Integration series.
Are you considering migrating from an older EHR to a newer EHR or are you in the process of that conversion? If so, you are well aware of the complexity of this process. There are a lot of reasons that drive the EHR conversion decision, but the primary reason that organizations undertake EHR conversion is simply to improve patient care and safety by providing clinicians and caregivers with the right information at the right time.

It’s easy to think that this is all about the technology. EHR conversion is far more than an IT project. It is a central business issue that needs to be strategically sponsored and backed by upper level management. In our previous post, we addressed the issue of aligning integration goals for business and technology. In a project of this magnitude, aligning business and technology goals becomes critical. Implementation takes hard work, time, and is very expensive. Effectively dealing with scope, budget & time creep, and change management matched to the stated business goals is the key to success. The complex planning needed is just one part of the story but the actual execution can be extremely problematic.

Since the primary reason for undertaking EHR conversion is to improve patient care and safety, clinical workflow is top-of-mind and coupled to data exchange and flow through your systems. On the IT side, your analysts define the project requirements and your developers build the interfaces based on those requirements. But the team that plays the most critical role is your quality team. Think of them as your project’s glue.

QA has layers of responsibilities. They are the ones that hold the requirements as the project blueprint and make sure that those requirements, driven by the pre-identified business needs, are being met. They also make sure that all defined processes are being followed. Where processes are not followed, QA defines the resulting risks that must be accommodated for in the system. A subset of responsibility for QA is in the final gate-keeping of a project, the testing and validation processes that address the functionality and metrics of a project.

Analysts work to build the interfaces and provide QA with expected workflows. If those workflows are not correctly defined, QA steps in to clarify them and the expected data exchange, and builds test cases to best represent that evolving knowledge. Identifying workflow is often done blindly with little or no existing information. Once the interface is built, those test cases become the basis for testing. QA also plays an important role in maintenance and in contributing to the library of artifacts that contribute to guaranteeing interoperability over time.

Though it is difficult to estimate the actual costs of interfacing due to the variance implicit in such projects, functional and integrated testing is often up to 3x more time consuming than development. It’s important to note that this most likely represents defects in the process. Normally, in traditional software development those numbers are inversed with QA taking about 1/3 of development time. It’s quite common that requirements are not complete by the time the project lands in QA’s lap. New requirements are continually discovered during testing. These are usually considered to be bugs but should have been identified before the development phase started. Another major reason for the lengthy time needed is that all testing is commonly done manually. A 25 minute fix may require hours of testing when done manually.

In technology projects, risk is always present. QA teams continuously work to confine and evaluate risk based on a predefined process and to report those issues. The question continually being asked is: what are the odds that X will be a problem? And how important is that impact if there is a problem? Here the devil is in the details. QA is constantly dancing with that devil. Risk is not an all or nothing kind of thing. If one were to try and eliminate all risk, projects would never be completed. QA adds order and definition to projects but there are always blind alleyways and unknown consequences that cannot be anticipated even with the most well defined requirements. Dealing with the unknown unknowns is a constant for QA teams. The question becomes how much risk can be tolerated to create the cleanest and most efficient exchange of date on an ongoing basis.

If QA is your glue, what are you doing to increase the quality of that glue, to turn that into super glue? What you can do is provide tools that offset the challenges your QA team faces. At the same time, these tools help contain project scope, time & budget creep, and maintain continual alignment with business goals. The right tools should help in the identification of requirements prior to interface development and throughout that process, identify the necessary workflows, and help in the QA process of building test cases. De-identification of PHI should be included so that production data can be used in testing. Tools should automate the testing and validation process and include the capability of running tests repetitively. In addition, these tools should provide easily shared traceability of the entire QA process by providing a central depository for all assets and documentation to provide continuity for the interoperability goals defined for the entire ecosystem.

What is your organization experiencing in your conversion projects? We’d love to hear your thoughts in the comments.

About Stéphane VigotStéphane Vigot, President of Caristix, has over 20 years of experience in product management and business development leadership roles in technology and healthcare IT. Formerly with CareFusion and Cardinal Health, his experience spans from major enterprises to startups. Caristix is one of the few companies in the health IT ecosystem that is uniquely focused on integrating, connecting, and exchanging data between systems. He can be reached at stephane.vigot@caristix.com

The following is a guest blog post by Stephane Vigot, President of Caristix, a leading provider of healthcare integration products and services. This post is part of the Optimize Healthcare Integration series.
The push for interoperability is on. What’s at the core of interoperability that truly supports next generation analytics, real patient engagement, true care coordination, and high value population health? Data exchange through interfacing. And that means HL7.

HL7 represents 95% of interfacing in hospital environments for clinical systems and many other information systems in healthcare. Many people make the error of thinking HL7 is just simple strings, but it’s a lot more than that. It’s a system of data organization, a dynamic framework that establishes the base of data exchange through its specifics, syntax and structure. But, despite standards, if you take two identical systems, same vendor, deployed in two different environments, you’ll find discrepancies 100% of the time when it comes to data management.

What’s the result? It takes too long to take systems live. And that means time, money, resource drain, and headaches for integrators, maintenance and quality teams. The most critical impact is on essential clinical care. Beyond that, this negatively impacts your short and long term business goals over time. This impact will grow with the increasing demands of interoperability, particularly with the drive for automation and easy data access and analytics.

There are three primary challenges that feed into this problem of getting a system live. These are:

Aligning the integration goals for business and technology users – This step alone will differentiate success or failure. Without a clear picture of your goals and environment from day one, you can’t measure the required investment and resources. Project planning becomes a wild guess. How do you get everyone involved on deck with a common understanding of the overall project? Is it crystal clear how your new system fits into your existing ecosystem in the context of your data flow and structure? Do you know what information you need from whom, when? Is all documentation readily available? Are the business impacts of the interface understood?

Complete and clear data transformation requirements – It’s common to manually compare outdated specs, list the differences and jump into the code. This makes it virtually impossible to quickly come up with a complete list. Complete requirements are not identified until too late in the project, sometimes not until it’s in production. Are all data flows and system workflows identified? Are the system’s data semantics clear? Are documented system specs accurate? Has customized data been included? Are all the transformations and mappings defined? Have you automated the processes that define requirements?

Testing/Verification – Your QA team knows this is about a lot more than making sure all the dots are connected. You want to get this right before your go live and avoid handling data related emergencies in production with constant break-fix repairs. Are you doing enough testing before go live so your caregivers can count on applications being completely functional for their critical patient care? Are your test cases based on your requirements? Are you testing against your clinical workflows? Do you include edge cases and performance in your testing? Are you testing with de-identified production data that accurately represents your system’s data flow and needs? Is your testing HIPAA compliant? Are you prepared for ongoing maintenance and updating with reusable test cases backed by reliable and repeatable quality measures? Is your testing automated?

What’s the most efficient solution to these three challenges? Productivity software that supports your integration and workflow process from start to finish. With the right solution, you understand the big picture before you start with complete requirements built upon your specifications that set you up for robust system testing and maintenance. The right solution will cut your project timelines in half, reduce your resource drain and costs, and guarantee predictable results while streamlining the repetitive tasks of your teams. In addition, gap analysis, automatic specification management, HL7 message comparison and editing, debugging tools, PHI de-identification, documentation building, and team collaborative depositories should be included. As seen in the charts below, savings of up to 52% can be realized through optimization with productivity software.
Do these healthcare integration challenges resonate with you? What is your organization experiencing? We’d love to hear your thoughts in the comments.

Caristix, a leading healthcare integration company, is the sponsor of the Optimize Healthcare Integration blog post series. If you’d like to learn more about how you can simplify your healthcare integration process, download this Free Whitepaper.

About Stéphane VigotStéphane Vigot, President of Caristix, has over 20 years of experience in product management and business development leadership roles in technology and healthcare IT. Formerly with CareFusion and Cardinal Health, his experience spans from major enterprises to startups. Caristix is one of the few companies in the health IT ecosystem that is uniquely focused on integrating, connecting, and exchanging data between systems. He can be reached at stephane.vigot@caristix.com

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I wanted to take a minute to spotlight the advertisers that support the work we do here at Hospital EMR and EHR. This site has grown much faster than I could have imagined. Considering the shift from ambulatory to hospital environments, this probably should be a surpise. Regardless, thanks so much for reading, sharing and commenting.

All of the posts are from the middle of 2011. So, maybe the top posts idea isn’t fair to those posts that were recently posted. Plus, from this list we can garner that our readers are very interested in Epic. In fact, the top post about becoming a Certified Epic consultant has had 3 times as much traffic as the other posts. Whether you like how Epic handles their certification, a lot of people seem interested in obtaining the Epic certification.

I also want to take a moment to recognize the advertisers who support all the work we do at Hospital EMR and EHR. The content here wouldn’t exist if it wasn’t for their support. If you enjoy what we do, check out their products and see what they have to offer your hospital.

Canon – This company really needs no introduction. They have some great scanner products. I have one on my desk and I love it. Heavy duty scanners are a must in the hospital EHR environment. Paper is still coming into your office, and with an EHR you usually want that paper stored electronically instead of in the now extinct paper chart. Just make sure you get a quality scanner so you don’t burn through a cheap one like I did when I first implemented an EHR many years ago.

Caristix – Need an HL7 interface? Check out Caristix to get it done faster. It’s always great for a hospital to have someone to look to when they need an HL7 interface done quickly. HL7 is going to be the dominate interface standard for the forseeable future. If you don’t have a good strategy for managing all the HL7 interfaces you have and the ones you’ll have in the future, then talk to Caristix.

GE Centricity Business – With Healthcare Reform circling over head and PPACA (Patient Protection an Affordable Care Act) upon us, we’re getting ready for a sea of changes when it comes to managing your revenue. The future of healthcare revenue is going to require a revenue management software like the one that GE business offers. Plus, the beauty of revenue cycle management software is that the purchase can be directly tied to profitability of your organization.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s been a really exciting period for Hospital EMR and EHR. I’ve been really proud of what we’ve built. Anne Zieger has been writing some really great content and I try to supplement it where I can. Thanks to that, the site has had a steady stream of traffic and we’ll soon have over 1000 email subscribers from most major hospital institutions. Not too bad for a relatively new blog that’s focused on such a tight niche.

Plus, we’ve recently gotten the support of a number of really amazing advertising partners. Without them, the work we do covering the hospital EMR and EHR world wouldn’t be possible. So, if you enjoy reading this site, then please take a moment to check out the following new advertisers.

Canon – I think we’re all quite familiar with Canon. They’re a great company that creates a lot of great products. The best product they make for healthcare is their high volume scanners (Although, I bet their printer division might argue this). I personally have a Canon high volume scanner by my work desk and I love it. While we’d love to get rid of paper in this new EHR world, it’s just not possible. So, a high volume scanner is a must. The Canon scanners are well worth checking out.

iChartsMD – iChartsMD recently launched their new Emergency Deparatment EHR software. They’ve been working hard in the EHR space to offer an affordable EHR that still can handle a fast moving workflow environment like in the ED. If you’re looking for an ED EHR solution, take a moment and check out what iChartsMD has created.

Caristix – When I first met Caristix, I could immediately tell that they were HL7 Interface experts. Everything about them, their website, and even their detailed HL7 Survival guide is focused on making HL7 easy for healthcare. Kind of reminds me of my post about the need for Interoperability Action, Not Talk. In order to make this a reality, we need more companies like Caristix that make HL7 interoperability easy.

A big thanks to all of these advertisers for their support. Also, thanks for reading the site. None of these advertisers would support us if you didn’t read. Hopefully we can continue to bring you great content about the crazy, fun, and exciting hospital health IT space.